1. Midwife Sarah Mast decides to start life over again in a new community. Moving is a common thing in English society, but relatively unusual for the Amish. Did you understand Sarah’s reasons for taking such a step? Did you think they were sound?

2. Have you ever moved to a new community? Who or what made you feel the most welcome and at home?

3. Who or what made Sarah feel at home in Pleasant Valley? Why?

4. Sarah is both shocked and in denial about the changes in her aunt. Have you ever encountered someone you haven’t seen in awhile and been shocked by how he or she has aged? Did you have a similar or different reaction?

5. Aaron’s hostility to the midwife practice takes Sarah by surprise, and she has difficulty understanding it. Have you ever experienced the discovery that someone you know has a radically different opinion on something important to you? How can a friendship survive such a situation?

6. When Sarah learns about the death of Aaron’s mother and his blaming her aunt, she immediately wants to “fix” the problem, as people with nurturing personalities often do. How did her aunt and Aaron respond to Sarah’s efforts? Did they think she was interfering? What might she have done?

7. Aaron’s relationship with his teenage brother, Benjamin, is a difficult one. Which of them did you empathize with the most? Did you understand Sarah’s longing to help them?

8. Did it surprise you to find that Amish teenagers have some of the same rebellious feelings as teenagers in the outside world? Why or why not?

9. Do you think the Amish are wise to allow their teenagers to experience the freedom they do in rumspringa? What are the dangers? What might be the dangers of not allowing it?

10. Sarah experiences varying reactions to midwifery during her career, from physicians who welcome her assistance to those who want to put her out of business. The court case was based in part on an actual case involving a midwife to the Amish in Pennsylvania. Why do you suppose some health care professionals are opposed to Amish midwives? Do you see a value in physicians and midwives working together?

11. Have you or someone you know experienced a midwife-assisted birth? What were your opinions of it?

12. Sarah’s relationship with her aunt goes through several transitions during Sarah’s first months in the practice. Do you see any of your relationships with older people or younger people reflected in Sarah’s experience? How? What qualities should people strive for when seeking the best relationships between generations?

13. It is not an easy thing for Amish people to take a stand on political or legal issues because of their history and beliefs. For the Amish of Pleasant Valley, showing their silent support of their midwife was a serious decision. Did you understand why they did that? Were you surprised that other groups would join them?

14. The birth of Molly’s baby is a crucial point in the relationship between Sarah and Aaron, when they are forced to face their deepest feelings. What are some times in the life of a family that bring out deep emotions? How can families grow through these experiences?

15. Do you think that Sarah will find comfort for her childless state in her clients and their babies? Or do you think this might make it more difficult for her as she and Aaron begin their married lives?